40% - 45% dari pasien rawat inap: kekurangan gizi atau berpotensi
kekurangan gizi.
50% dari pasien bedah adalah malnutrisi
12% gizi buruk.
Komplikasi 3 kali lebih tinggi Kematian yang lebih tinggi, LOS lebih
lama, Biaya rumah sakit naik 35% -75%
Effects of malnutrition on recovery
process
30 - 55% pasien; 25% pasien anak di rumah sakit mengalami
kekurangan gizi
ERAS programme
a multimodal approach that aims to optimize perioperative
management
a package of evidence-based modifications in preoperative,
intraoperative, and postoperative elements of care to reduce surgical
stress and postoperative catabolism
Preoperative fasting
CHO loading
800 ml CHO drinks (12,5%) evening before surgery
400 ml CHO drinks (12,5%) 2 hours before anesthesia
The enteral route should always be preferred except for the following
contraindications:
Intestinal obstructions or ileus,
Severe shock
Intestinal ischaemia
High output fistula
Severe intestinal haemorrhage
Advantages:
Does not require surgery
Less risk of sepsis than central TPN
No risk of mechanical complications
Disadvantages:
High risk of thrombophlebitis
Painful
Does not provide full nutrition support. Needs more
fluids to provide more nutrition. (maximum dextrose
= 7.5% and AA = 2.5%).
Monitoring
Monitoring
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Avoid overfeeding
Avoid respiratory problem
Promote nitrogen retention
Triglyceride clearance
Fluid and electrolyte
Weight
Liver function
Monitoring for Complications
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Malnourished patients at risk for refeeding syndrome should
have serum phosphorus, magnesium, potassium, and glucose
levels monitored closely
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Serum electrolytes (sodium, potassium, chloride, and
bicarbonate) should be monitored frequently until
measurements are stable.